Alaska Lawmakers Push for Telehealth Expansion in 'Frontier' States

Lawmakers from one of the nation’s most rural states are seeking to make it easier for so-called “frontier” states to use telehealth for mental health access and treatment.

Both the House and Senate have seen bills filed this month called for the expansion of telemental health services in frontier states. Neither the bill filed on July 2 by Alaska Senator Dan Sullivan nor the bill filed on July 9 by Alaska Congressmen Don Young have any text attached to them yet.

Both bills address a common refrain in connected health: the use of telemedicine and mHealth platforms and tools to help rural and remote residents access healthcare, and to help providers in those areas reach out to more residents. The issue is particularly acute in mental health, brought on by the stresses of the coronavirus pandemic and a shortage of providers.

The bills cite a classification for rural states that was developed by the US Department of Agriculture’s Economic Research Service (ERS) in partnership with the Federal Office of Rural Health Policy roughly 10 years ago, based on the 2010 census.

According to a policy brief prepared by the National Rural Health Association, the Affordable Care Act was the first policy document to recognize frontier regions, with the Centers for Medicare & Medicaid Services identifying Alaska, Montana, Nevada, North and South Dakota and Wyoming for Medicare reimbursement considerations.

In addition, in 2006 a panel formed by the US Health Resources and Services Administration’s Office for the Advancement of Telehealth created a new definition for frontier: “ZIP code areas whose calculated population centers are more than 60 minutes or 60 miles along the fastest paved road trip to a short-term non-federal general hospital of 75 beds or more, and are not part of a large rural town with a concentration of over 20,000 population.” The panel included in that definition a process to redefine the term or add regions that might qualify as frontiers under different characteristics.

The bills submitted by the Alaska lawmakers also highlight a challenge facing the telehealth community: Should rules be enacted that increase telehealth access in rural areas but not urban regions or areas that fall in between?

Advocates have long argued that city residents face just as many challenges in accessing healthcare as those living in remote areas, and some have said legislation and policy should focus on eliminating geographical barriers rather than supporting them. Others say remote regions are ideal locations for creating telehealth programs that quickly prove their value, which in turn could be used to advocate for improved Medicare coverage.